<!DOCTYPE html>
<html>
<head>
  <meta charset="utf-8">
  <title>Layui</title>
  <meta name="renderer" content="webkit">
  <meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1">
  <meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1">
  <link rel="stylesheet" href="./layui/css/layui.css"  media="all">
  <!-- 注意：如果你直接复制所有代码到本地，上述css路径需要改成你本地的 -->
</head>
<body>
    <table class="layui-table">
        <colgroup>
          <col width="150">
          <col width="200">
          <col>
        </colgroup>
        <thead>
          <tr>
            入院登记
          </tr> 
        </thead>
        <tbody>
            <th>
              <td>患者姓名</td><td>患者账号</td><td>患者电话</td><td>患者紧急联系人</td><td>患者紧急联系人电话</td><td>医生姓名</td><td>医生科室</td><td>医生电话</td><td>操作</td>
            </th>
            <tr>
              
            </tr>
          <tr>
            <form class="layui-form" action="">
                <div class="layui-form-item">
                  <label class="layui-form-label">单行输入框</label>
                  <div class="layui-input-block">
                    <input type="text" name="title" lay-verify="title" autocomplete="off" placeholder="请输入标题" class="layui-input">
                  </div>
                </div>
                <div class="layui-form-item">
                  <label class="layui-form-label">验证必填项</label>
                  <div class="layui-input-block">
                    <input type="text" name="username" lay-verify="required" lay-reqtext="用户名是必填项，岂能为空？" placeholder="请输入" autocomplete="off" class="layui-input">
                  </div>
                </div>
                
                <div class="layui-form-item">
                  <div class="layui-inline">
                    <label class="layui-form-label">验证手机</label>
                    <div class="layui-input-inline">
                      <input type="tel" name="phone" lay-verify="required|phone" autocomplete="off" class="layui-input">
                    </div>
                  </div>
                  <div class="layui-inline">
                    <label class="layui-form-label">验证邮箱</label>
                    <div class="layui-input-inline">
                      <input type="text" name="email" lay-verify="email" autocomplete="off" class="layui-input">
                    </div>
                  </div>
                </div>
                
                <div class="layui-form-item">
                  <div class="layui-inline">
                    <label class="layui-form-label">多规则验证</label>
                    <div class="layui-input-inline">
                      <input type="text" name="number" lay-verify="required|number" autocomplete="off" class="layui-input">
                    </div>
                  </div>
                  <div class="layui-inline">
                    <label class="layui-form-label">验证日期</label>
                    <div class="layui-input-inline">
                      <input type="text" name="date" id="date" lay-verify="date" placeholder="yyyy-MM-dd" autocomplete="off" class="layui-input">
                    </div>
                  </div>
                  <div class="layui-inline">
                    <label class="layui-form-label">验证链接</label>
                    <div class="layui-input-inline">
                      <input type="tel" name="url" lay-verify="url" autocomplete="off" class="layui-input">
                    </div>
                  </div>
                </div>
                
                <div class="layui-form-item">
                  <label class="layui-form-label">验证身份证</label>
                  <div class="layui-input-block">
                    <input type="text" name="identity" lay-verify="identity" placeholder="" autocomplete="off" class="layui-input">
                  </div>
                </div>
                <div class="layui-form-item">
                  <label class="layui-form-label">自定义验证</label>
                  <div class="layui-input-inline">
                    <input type="password" name="password" lay-verify="pass" placeholder="请输入密码" autocomplete="off" class="layui-input">
                  </div>
                  <div class="layui-form-mid layui-word-aux">请填写6到12位密码</div>
                </div>
                
                <div class="layui-form-item">
                  <div class="layui-inline">
                    <label class="layui-form-label">范围</label>
                    <div class="layui-input-inline" style="width: 100px;">
                      <input type="text" name="price_min" placeholder="￥" autocomplete="off" class="layui-input">
                    </div>
                    <div class="layui-form-mid">-</div>
                    <div class="layui-input-inline" style="width: 100px;">
                      <input type="text" name="price_max" placeholder="￥" autocomplete="off" class="layui-input">
                    </div>
                  </div>
                </div>
                
                <div class="layui-form-item">
                  <label class="layui-form-label">单行选择框</label>
                  <div class="layui-input-block">
                    <select name="interest" lay-filter="aihao">
                      <option value=""></option>
                      <option value="0">写作</option>
                      <option value="1" selected="">阅读</option>
                      <option value="2">游戏</option>
                      <option value="3">音乐</option>
                      <option value="4">旅行</option>
                    </select>
                  </div>
                </div>
                
                
                <div class="layui-form-item">
                  <div class="layui-inline">
                    <label class="layui-form-label">分组选择框</label>
                    <div class="layui-input-inline">
                      <select name="quiz">
                        <option value="">请选择问题</option>
                        <optgroup label="城市记忆">
                          <option value="你工作的第一个城市">你工作的第一个城市</option>
                        </optgroup>
                        <optgroup label="学生时代">
                          <option value="你的工号">你的工号</option>
                          <option value="你最喜欢的老师">你最喜欢的老师</option>
                        </optgroup>
                      </select>
                    </div>
                  </div>
                  <div class="layui-inline">
                    <label class="layui-form-label">搜索选择框</label>
                    <div class="layui-input-inline">
                      <select name="modules" lay-verify="required" lay-search="">
                        <option value="">直接选择或搜索选择</option>
                        <option value="1">layer</option>
                        <option value="2">form</option>
                        <option value="3">layim</option>
                        <option value="4">element</option>
                        <option value="5">laytpl</option>
                        <option value="6">upload</option>
                        <option value="7">laydate</option>
                        <option value="8">laypage</option>
                        <option value="9">flow</option>
                        <option value="10">util</option>
                        <option value="11">code</option>
                        <option value="12">tree</option>
                        <option value="13">layedit</option>
                        <option value="14">nav</option>
                        <option value="15">tab</option>
                        <option value="16">table</option>
                        <option value="17">select</option>
                        <option value="18">checkbox</option>
                        <option value="19">switch</option>
                        <option value="20">radio</option>
                      </select>
                    </div>
                  </div>
                </div>
                
                <div class="layui-form-item">
                  <label class="layui-form-label">联动选择框</label>
                  <div class="layui-input-inline">
                    <select name="quiz1">
                      <option value="">请选择省</option>
                      <option value="浙江" selected="">浙江省</option>
                      <option value="你的工号">江西省</option>
                      <option value="你最喜欢的老师">福建省</option>
                    </select>
                  </div>
                  <div class="layui-input-inline">
                    <select name="quiz2">
                      <option value="">请选择市</option>
                      <option value="杭州">杭州</option>
                      <option value="宁波" disabled="">宁波</option>
                      <option value="温州">温州</option>
                      <option value="温州">台州</option>
                      <option value="温州">绍兴</option>
                    </select>
                  </div>
                  <div class="layui-input-inline">
                    <select name="quiz3">
                      <option value="">请选择县/区</option>
                      <option value="西湖区">西湖区</option>
                      <option value="余杭区">余杭区</option>
                      <option value="拱墅区">临安市</option>
                    </select>
                  </div>
                  <div class="layui-form-mid layui-word-aux">此处只是演示联动排版，并未做联动交互</div>
                </div>
                
                <div class="layui-form-item">
                  <label class="layui-form-label">复选框</label>
                  <div class="layui-input-block">
                    <input type="checkbox" name="like[write]" title="写作">
                    <input type="checkbox" name="like[read]" title="阅读" checked="">
                    <input type="checkbox" name="like[game]" title="游戏">
                  </div>
                </div>
                
                <div class="layui-form-item" pane="">
                  <label class="layui-form-label">原始复选框</label>
                  <div class="layui-input-block">
                    <input type="checkbox" name="like1[write]" lay-skin="primary" title="写作" checked="">
                    <input type="checkbox" name="like1[read]" lay-skin="primary" title="阅读">
                    <input type="checkbox" name="like1[game]" lay-skin="primary" title="游戏" disabled="">
                  </div>
                </div>
                
                <div class="layui-form-item">
                  <label class="layui-form-label">开关-默认关</label>
                  <div class="layui-input-block">
                    <input type="checkbox" name="close" lay-skin="switch" lay-text="ON|OFF">
                  </div>
                </div>
                <div class="layui-form-item">
                  <label class="layui-form-label">开关-默认开</label>
                  <div class="layui-input-block">
                    <input type="checkbox" checked="" name="open" lay-skin="switch" lay-filter="switchTest" lay-text="ON|OFF">
                  </div>
                </div>
                <div class="layui-form-item">
                  <label class="layui-form-label">单选框</label>
                  <div class="layui-input-block">
                    <input type="radio" name="sex" value="男" title="男" checked="">
                    <input type="radio" name="sex" value="女" title="女">
                    <input type="radio" name="sex" value="禁" title="禁用" disabled="">
                  </div>
                </div>
                <div class="layui-form-item layui-form-text">
                  <label class="layui-form-label">普通文本域</label>
                  <div class="layui-input-block">
                    <textarea placeholder="请输入内容" class="layui-textarea"></textarea>
                  </div>
                </div>
                <!--<div class="layui-form-item layui-form-text">
                  <label class="layui-form-label">编辑器</label>
                  <div class="layui-input-block">
                    <textarea class="layui-textarea layui-hide" name="content" lay-verify="content" id="LAY_demo_editor"></textarea>
                  </div>
                </div>-->
                <div class="layui-form-item">
                  <div class="layui-input-block">
                    <button type="submit" class="layui-btn" lay-submit="" lay-filter="demo1">立即提交</button>
                    <button type="reset" class="layui-btn layui-btn-primary">重置</button>
                  </div>
                </div>
              </form>
          </tr>
          
        </tbody>
      </table>



<script src="./layui/layui.js" charset="utf-8"></script>
<!-- 注意：如果你直接复制所有代码到本地，上述 JS 路径需要改成你本地的 -->
<script>
layui.use(['form', 'layedit', 'laydate'], function(){
  var form = layui.form
  ,layer = layui.layer
  ,layedit = layui.layedit
  ,laydate = layui.laydate;
  
  //日期
  laydate.render({
    elem: '#date'
  });
  laydate.render({
    elem: '#date1'
  });
  
  //创建一个编辑器
  var editIndex = layedit.build('LAY_demo_editor');
 
  //自定义验证规则
  form.verify({
    title: function(value){
      if(value.length < 5){
        return '标题至少得5个字符啊';
      }
    }
    ,pass: [
      /^[\S]{6,12}$/
      ,'密码必须6到12位，且不能出现空格'
    ]
    ,content: function(value){
      layedit.sync(editIndex);
    }
  });
  
  //监听指定开关
  form.on('switch(switchTest)', function(data){
    layer.msg('开关checked：'+ (this.checked ? 'true' : 'false'), {
      offset: '6px'
    });
    layer.tips('温馨提示：请注意开关状态的文字可以随意定义，而不仅仅是ON|OFF', data.othis)
  });
  
  //监听提交
  form.on('submit(demo1)', function(data){
    layer.alert(JSON.stringify(data.field), {
      title: '最终的提交信息'
    })
    return false;
  });
 
  //表单赋值
  layui.$('#LAY-component-form-setval').on('click', function(){
    form.val('example', {
      "username": "贤心" // "name": "value"
      ,"password": "123456"
      ,"interest": 1
      ,"like[write]": true //复选框选中状态
      ,"close": true //开关状态
      ,"sex": "女"
      ,"desc": "我爱 layui"
    });
  });
  
  //表单取值
  layui.$('#LAY-component-form-getval').on('click', function(){
    var data = form.val('example');
    alert(JSON.stringify(data));
  });
  
});
</script>

</body>
</html>